Tireless Price Transparency Advocate Shows No Sign of Slowing Down

By Bruce Shutan - Marilyn Bartlett, now a senior policy fellow with the National Academy for State Health Policy (NASHP), began her groundbreaking work to advance hospital price transparency when she was Montana Employee Benefit Plan (MEBP) administrator. Her work for state-run employee health plans to secure transparent and reasonable prices from hospitals through reference-based pricing (RBP) garnered national attention. A self-described “accounting nerd,” who on occasion dons debit-and-credit earrings, Bartlett could never understand why anyone would agree to discounts off a hospital charge description master. Read Full Article…

HVBA Article Summary

1. Advancing Cost-Plus and Medicare-Based Pricing Models: Bartlett has championed the use of reference-based pricing (RBP) by tying costs to a percentage of Medicare rates, helping to control rising health care expenses. Her efforts in Montana led to a major financial turnaround, inspiring other states to adopt similar models.

2. Driving Health Care Transparency and Policy Reform: Through her work with NASHP and Patient Rights Advocate, Bartlett has helped develop tools to analyze hospital financials and has played a key role in advocating for transparency laws, including the Health Care Prices Revealed and Information to Consumers Explained Transparency Act.

3. Challenging Industry Middlemen and Promoting Fiduciary Responsibility: Bartlett has actively fought against the influence of large insurance carriers, pharmacy benefit managers (PBMs), and third-party administrators that drive up costs. She has worked to eliminate waste, improve employer group health plan oversight, and ensure fairer pricing structures for patients and payers.

More than 65 Organizations Call on Workplaces to Provide Comprehensive Obesity Care Coverage

By Marissa Plescia - In a recent open letter addressed to America’s employers, 68 organizations urged companies to cover obesity care just like any other chronic disease. The letter was led by the Alliance for Women’s Health and Prevention and included participation from the Society for Women’s Health Research, the National Alliance of Healthcare Purchaser Coalitions and several others. It’s part of a campaign that the Alliance for Women’s Health and Prevention (AWHP) launched last year called EveryBODY Covered, which aims to improve insurance coverage for obesity. Read Full Article…

HVBA Article Summary

1. Comprehensive Obesity Coverage: Organizations advocate for employers to provide full-spectrum obesity care, including medical nutrition therapy, intensive behavioral therapy, surgery, and medications, to ensure effective treatment and management.

2. Economic and Workplace Impact: Untreated obesity costs employers approximately $425.5 billion annually, and lack of coverage forces individuals to seek unsafe alternatives or forgo treatment. Expanding coverage can improve workforce health, increase productivity, and reduce absenteeism.

3. Addressing Stigma and Equity: Women, particularly women of color, face significant disparities related to obesity, including health risks, workplace discrimination, and wage gaps. Employers should recognize obesity as a chronic disease, review health benefits, combat weight bias, and provide necessary accommodations to support affected employees.

The promise and peril of AI in health care: Risks, policies and human oversight

By Melissa Menard - Artificial intelligence (AI) is revolutionizing health care, heralding diagnostics, treatment, and patient care breakthroughs. As of 2024, approximately 43% of health care leaders reported utilizing AI for in-hospital patient monitoring, with 85% planning further AI investments soon. From detecting diseases earlier and enhancing the decision-making process for treatment options, to optimizing hospital workflows, AI’s transformative potential is clear. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Human Oversight in AI Implementation: Despite AI’s advancements, human oversight remains essential to ensure ethical and effective healthcare. AI models can produce biased or inaccurate recommendations due to incomplete data or a lack of contextual understanding. Rigorous testing, bias detection audits, and periodic reviews must be conducted to mitigate risks and ensure AI-generated insights are critically assessed by healthcare professionals before influencing patient care.

2. Cybersecurity and Data Privacy Protections: The integration of AI in healthcare heightens cybersecurity risks, including ransomware attacks and data breaches that can compromise patient safety. To safeguard sensitive information, organizations must implement strong encryption, multi-factor authentication, continuous monitoring, and strict vetting of AI vendors to ensure compliance with high security standards.

3. AI’s Role in Advancing Health Equity: AI has the potential to bridge healthcare disparities by optimizing appointment scheduling, enhancing telemedicine access, and analyzing social determinants of health to tailor patient care. However, to maximize these benefits, AI models must be trained on diverse datasets to avoid perpetuating existing inequities and ensure fair, inclusive healthcare outcomes.

CMS scraps contracts to upgrade online Medicare system and hands over control to DOGE, agency says

By Noah Tong - Contractors working to modernize a provider enrollment system have been shown the door, the Centers for Medicare & Medicaid Services (CMS) announced. Instead, CMS will work with the highly influential advisory group Department of Government Efficiency (DOGE) to complete a system overhaul that will be far less costly and time-consuming, the agency said. Read Full Article…

HVBA Article Summary

1. Failed Modernization Efforts and Contract Cancellations: After nine years and $200 million spent with no usable output, CMS canceled two contractor agreements aimed at modernizing the Medicare provider enrollment system (PECOS). The agency now seeks to accelerate development by hiring software engineers and working with DOGE, a government watchdog known for exposing wasteful spending.

2. Transparency Concerns and Industry Skepticism: While CMS asserts cost savings from contract cancellations, experts question the lack of transparency regarding the exact contracts terminated. Industry voices warn that modernization efforts require sustained expertise, and sudden shifts in project leadership—without clear accountability—could lead to further inefficiencies or disruptions.

3. Potential Risks of a Rapid Overhaul: Although PECOS 2.0 aimed to streamline provider enrollment and reduce inefficiencies, industry professionals worry that abruptly shifting to a new development approach could jeopardize system reliability. Concerns include inadequate support for long-term maintenance, lack of industry stakeholder input, and unintended consequences that could affect provider payments and access to Medicare services.

Employees seek balance between health care premiums and out-of-pocket expenses

By Alan Goforth - Although salary remans king, employees also value benefits as part of an overall compensation package. “In a tight labor market, employees have choices,” according to the latest employee benefits survey from ADP. “Compensation is always foremost, but a close second are the benefits an employer offers. Read Full Article…  ^{_{(Subscription required)}}  

HVBA Article Summary

1. Compensation and Benefits as Key Retention Factors: Employees evaluate the entire compensation package, including salary and benefits, when deciding whether to accept or stay in a job. While compensation remains the top priority, benefits—both medical and non-medical—play a crucial role in making employees feel valued.

2. Evolving Benefit Priorities and Financial Wellness: The importance of 401(k) plans has risen significantly, tying with dental insurance as the second-most valued benefit. This trend reflects employees' increasing focus on financial wellness, with gender differences highlighting varying priorities in long-term financial planning.

3. The Shift Toward Personalized and Flexible Benefits: Employees seek benefits that align with their individual and family needs, with three-quarters expressing interest in personalized recommendations. Despite the value placed on employer-provided benefits, voluntary benefits remain underutilized, presenting an opportunity for companies to enhance employee satisfaction and retention through more tailored offerings.

Aetna Alleges Conspiracy Among Generic Pharmaceutical Manufacturers

By Thomas Sullivan - Aetna recently filed a lawsuit against pharmaceutical manufacturers for allegedly conspiring to overcharge the insurer for generic drugs. According to the Complaint, the pharmaceutical companies engaged in secret communications and meetings to fix the prices of certain generic medications, which increased costs for insurers, patients, and the government. Read Full Article…

HVBA Article Summary

1. Coordinated Price Manipulation: The defendants, including major pharmaceutical companies such as Teva, Sandoz, Pfizer, and Mylan, allegedly conspired to manipulate the prices of generic drugs, leading to significant overcharges for Aetna and other purchasers. They reportedly used industry trade groups, personal meetings, and electronic communications to coordinate pricing strategies and market division.

2. Market Allocation and Bid-Rigging: The complaint alleges that the defendants operated under a “fair share” arrangement, ensuring that each company maintained a portion of the market without competing on price. Executives allegedly attended industry events and used direct communication methods to discuss bid-rigging strategies and market share agreements, attempting to evade detection by avoiding written records.

3. Legal and Regulatory Actions: Aetna’s complaint is part of broader litigation against pharmaceutical companies for alleged price-fixing in the generic drug market. Federal and state investigations, as well as lawsuits filed by state attorneys general and other insurers, have accused these manufacturers of similar anticompetitive conduct. Several companies, including Teva and Glenmark Pharmaceuticals, have already settled with the Department of Justice.

Why Ozempic might help tackle aging

By Alexandra Murphy - Glucagon-like peptide-1 receptor agonists such as Ozempic, originally developed for diabetes management and later approved for weight loss, are being studied for their potential to address age-related diseases, The Wall Street Journal reported March 10. Read Full Article…  

HVBA Article Summary

1. Expanding Health Benefits: Research suggests that GLP-1s may offer benefits beyond their initial use for diabetes and weight management, potentially helping with age-related conditions such as Alzheimer's, osteoarthritis, and even reducing mortality risk.

2. Growing Interest in Longevity: Longevity clinics are increasingly marketing GLP-1s as gerotherapeutics, recognizing their potential to target biological aging processes. A review by Nir Barzilai, MD, found that GLP-1s ranked among the top drugs for extending lifespan and health span.

3. Impact Beyond Weight Loss: While GLP-1s primarily suppress appetite, their benefits may extend beyond weight management. Research indicates that semaglutide provides cardiovascular benefits even for individuals with heart disease, regardless of their initial weight or weight loss.

HAFA looks to ‘take our industry back’ in 2025

By Susan Rupe - This is the year the health insurance agents “take our industry back for good,” the president and CEO of Health Agents for America told InsuranceNewsNet. “That is the goal. That is the vision. That's where we're going,” Ronnell Nolan said of her association’s plans for the coming year. Read Full Article…

HVBA Article Summary

1. HAFA’s Advocacy for Agents and Brokers: HAFA has actively spoken out against policies that negatively impact health insurance agents, including CMS suspensions based on algorithmic targeting and the elimination of commissions for certain Medicare Advantage and Part D plans. Nolan emphasized the need to restore short-term medical coverage to provide more choices for clients.

2. Concerns Over Fraud and Regulatory Issues: Despite CMS efforts to prevent fraudulent enrollments, HAFA asserts that rogue agents continue to illegally change people’s plans without consent. Nolan stressed the urgency of addressing this issue before the next open enrollment period to protect both agents and consumers.

3. Uncertainty Around ACA Subsidies and Policy Shifts: HAFA is surveying its members on the potential expiration of expanded ACA tax subsidies, which are set to sunset at the end of 2024. While some agents support their extension for business reasons, concerns remain about their impact on the federal deficit. Meanwhile, Nolan notes that health care is not a top priority for the new administration, though there is optimism about CMS leadership recognizing the role of agents.